HomeMy WebLinkAbout08-29-05
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The Law Office of
MARIELLE F. HAzEN
Certified Elder Law Attorney*
An Estate Planning and Elder Law Firm
2000 Linglestown Road
Suite 202
Harrisburg, PA 17110
TEL: (717) 540-4332
FAX: (717) 540-4313
www.hazenelderlaw.com
Marlelle F. Hazen, JD, CElA *
Jeta C. Combs, Paralegal
Jessica A. Holland, Paralegal
Catherine M. Semon, Paralegal
Kim M. Smith, Office Administrator
August 25, 2005
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013-3387
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Re:
Estate of Esther E. Mairs
File No. 21-05-0562
Inheritance Tax Return
To: The Register of Wills:
Enclosed for filing please find the original and one copy of the above-referenced
Inheritance Tax Return and Inventory, along with a copy of the first page of the
Inheritance Tax Return. Please date stamp the first page of the return and a copy of the
Inventory and return them to my office in the enclosed self-addressed envelope.
Enclosed please also find a check in the amount of $42.17 for payment of the
inheritance tax and one in the amount of $30.00 for the filing fee.
If you have any questions or require any additional information, please do not
hesitate to contact me.
~inc~.relY&
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,
,
ta Combs
Paralegal
Enclosures
cc: Donna Weber
'Certified Elder Law Attorney by the National Elder Law Foundation as authorized by the Pennsylvania Supreme Court
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REV-1500 EX + (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-{)601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (lAST, FIRST, AND MIDDLE INITIAL)
Esther E. Mairs
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 5 0 5 6 2
"'CoUNTYCOOE ---YEAR""" - - NUMsER- -
SOCIAL SECURITY NUMBER
1 60- 2 6 - 9 243
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Retum Idate of death prior to 12-13-82)
o 5. Federal Estate Tax Retum Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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08/04/2004 03/05/1931
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST, FIRST, AND MIDDLE INITIAL)
[X] 1. Original Retum
o 4. Limited Estate
o 6. Decedent Died Testate (AttachcopyofWm)
o 9. Litigation Proceeds Received
o 2. Supplemental Retum
o 4a. Future Interest Compromise (date of death aIler 12-12.82)
o 7. Decedent Maintained a Living Trust (Attach copyotTrust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
COMPLETE MAILING ADDRESS
2000 Linglestown Road, Suite 202
I
PA 17110
OFFICIAL USE ONLY l
I
0.00 X _(15) 0.00
937.10 x .045 (16) 42.17
0.00 x .12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 42.17
NAME
Marielle F. Hazen
FIRM NAME (If Applicable)
Law Office of Marielle F. Hazen
TELEPHONE NUMBER
717-540-4332
Harrisbur
,--',
(1)
(2)
(3)
(4)
(5)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(6)
(7)
(9)
(10)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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2,127.74 :
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(8)
2,127.74
1 ,097.81
92.83
(11)
(12)
(13)
1,190.64
937.10
(14)
937.10
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Add
ece en s omPlete ress:
STREET ADDRESS
324 Charles Street
CITY I STATE -, ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
42.17
Total Credits (A + B + C)
(2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( 0 + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ........................................................................... 0 [XJ
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 [XJ
c. retain a reversionary interest; or ...................................................................................................... 0 [XJ
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 [XJ
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?...... ....................... ....... ............ ........ ............. ....... .................. 0 [XJ
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 [XJ
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 [XJ
0.00
0.00
42.17
42.17
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
ADDRESS 411 Daria Road
MechanicsburQ
SIGNATURE OF PREPARER OTHER THA
PA 17055
DATE
g - 2-J"r U-S
ADDRESS
PA 17110
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. 99116 (a) (1.1) (ill.
For dates of de,"" -- -" .
The stat.u~e doe t.. \ A P D
the surviVing SPI I '-l
For dates of dea
The tax rate imp
or a stepparent (
The tax rate imp!
The tax rate imp(
individual who he
nposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)].
! from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
:eased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
"3 ?. '-.;, S\'
3 use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)].
~ use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an
:edent, whether by blood or adoption.
REV-1508 EX + (6-98)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Esther E. Mairs
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
21 05
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
0562
ITEM
NUMBER
1.
DESCRIPTION
Church of God
Refund - Payable the Estate of Esther Mairs
VALUE AT DATE
OF DEATH
2,127.74
TOT At {Also enter on line 5, Recapitulation} $
(If more space is needed. insert additional sheets of the same size)
2127.74
REV-1511 EX + (12-99)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Esther E. Mairs
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21
05
0562
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Myers Funeral Home 233.82
2. Funeral Dress 59.99
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attomey Fees Marielle F. Hazen 750.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills - Open Probate 54.00
5. Accountanfs Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 1 097.81
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
*'
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Esther E. Mairs
FILE NUMBER
21 05
Include unreimbursed medical expenses.
0562
VALUE AT DATE
OF DEATH
ITEM
NUMBER DESCRIPTION
1. Kenneth Guistwite, MD
Medical Bill
2. Philhaven
Medical Bill
19.12
73.71
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
92.83
ReV-""~"'"
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
Esther F. M~ir~ ?1 05 0562
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Donna L. Weber Lineal
411 Daria Road 100%
Mechanicsburg, PA 17055
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
REGISTER OF WILLS OF CUMBERLAND COUNTY
INVENTORY
, Deceased
No. 21 05 0562
Date of Death 8/4/2004
Social Security No. 160269243
Estate of Esther E. Mairs
also known as
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We
verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Personal Representative:
Name of
Attomey: Marielle F. Hazen
1.0. No.: 68003
Address: 2000 Linglestown Road, Suite 202
Harrisburg
Telephone: 717-540-4332
Donna Weber
Dated
PA 17110
Description
Value
Church of God
Refund - Payable the Estate of Esther Mairs
2,127.74
Total
2,127.74
(Attach Additional Sheets If necessary)
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 17128-0601
REV-1162 EXI11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WEBER DONNA L
411 DARLA ROAD
MECHANICSBURG, PA 17055
-.-~---- fold
ESTATE INFORMATION: SSN: 160-26-9243
FILE NUMBER: 2105-0562
DECEDENT NAME: MAIRS ESTHER E
DATE OF PAYMENT: 08/29/2005
POSTMARK DATE: 08/26/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 08/04/2004
NO. CD 005733
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $42.17
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TOTAL AMOUNT PAID:
$42.17
REMARKS:
CHECK# 4323
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
-.L
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS